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INTRODUCTION

This publication provides a brief overview of the incidence of the types of cancer suffered, prevalence and other characteristics, cancer screening practices, trends in morbidity and mortality in Australia.


DATA SOURCES

This article presents information from a number of sources, including the 2001 and 2004-05 ABS National Health Survey (NHS), 2004 Causes of Death data, and national cancer registry data published by the AIHW. It should be noted that the 2001 and 2004-05 NHS excluded persons in hospitals, nursing and convalescent homes and hospices and hence the data relates only to persons in private dwellings. The registration of all cancers (excluding non-melanoma skin cancer) is required by law in each of the states and territories and data about people with newly diagnosed cancer from hospitals, pathologists, radiation oncologists (cancer specialists), cancer treatment centres and nursing homes are collated by cancer registries.


INQUIRIES

For further information about these and related statistics, contact the National Information and Referral Service on 1300 135 070 or email client.services@abs.gov.au.


CALCULATION OF RATES

In this article incidence and prevalence rates are presented. Incidence refers to the number of new cases of a particular characteristic, such as cancer, which occur within a certain period. This differs from prevalence, which refers to the number of cases of a particular characteristic that are present in a population at one point in time. Incidence and prevalence rates are proportions of the population of interest.


CANCER

Cancer is a major disease in Australia, and represents one of the major causes of death (AIHW & AACR 2004).

Cancer is a disease of the body's cells. Normally, cells grow and reproduce in an orderly manner. Sometimes, though, abnormal cells will grow. These abnormal cells may then reproduce and spread uncontrolled throughout the body. Cancer is the term used to describe about 100 different diseases including malignant tumours, leukaemia (a disorder of the white blood cells), sarcoma of the bones, Hodgkin's disease and non-Hodgkin's lymphoma (affecting the lymph nodes) in which uncontrolled cell growth threatens the rest of the body (The Cancer Council of Australia 2006).

In 2003, cancer was the leading contributor to the overall burden of disease amongst Australians (19%). Of Australia's total burden of disease, lung cancer, colorectal cancer and breast cancer were the leading specific types of cancer contributing to Australia's total burden of disease (3% and 2% each respectively) (AIHW 2006b).

Cancer surveillance in Australia relies on good incidence and mortality data. Cancer is a notifiable disease in Australia and is the only major disease category for which there is almost complete coverage in terms of incidence.


INCIDENCE

• In 2001 there were 88,398 new cases of cancer reported (AIHW & AACR 2004).
• Data from cancer registries show that in 2001 colorectal cancers (footnote 1) were the most common newly diagnosed cancers with 12,844 new cases of bowel or colorectal cancer reported (AIHW & AACR 2004).
• In 2001, prostate cancer was the most common diagnosed registrable cancer among males (11,191 new cases diagnosed). Following prostate cancer, the most common registerable cancers in males were colorectal cancers (6,861 new cases diagnosed), lung cancer (5,384) and melanoma (5,024) (AIHW & AACR 2004).
• Breast cancer was the most common newly diagnosed cancer among females in 2001 (11,791 new cases diagnosed). After breast cancer, colorectal cancer (5,883 new cases), colon (4,085) and melanoma (3,861) were the next most common registrable cancers among females (AIHW & AACR 2004).

Incidence of selected cancers (a) - 2001

• Prevalence data (as a measure of all those suffering from cancer at a point in time and living in private dwellings) is much higher than incidence data (all those in the population who were diagnosed with cancer in a specific period) (AIHW & AACR 2004).
• In 2004-05, 2% of the population (about 390,000 people) reported that they currently had a medically diagnosed neoplasm. Of these people, 87% reported that they had a malignant neoplasm (cancer) and 14% reported that they had a benign neoplasm or neoplasm of an uncertain nature.
• There has been a significant increase between 2001 and 2004-05 in the number of people who reported that they had malignant skin cancer (94,300 and 147,900 respectively), however, the overall number of people reporting a medically diagnosed neoplasm of any kind has not significantly changed.

• In 2004-05, of all persons who reported that they had a medically diagnosed neoplasm (cancer), there was a greater number of men reporting the condition (53%) than women (47%).
• Cancer was most prevalent in the 65 years and over age group (11% of males and 4% of females in this age group reported having cancer).

• Cancer was the main underlying cause of death in Australia in 2002, 2003 and 2004, causing 28% of all deaths each year (ABS 2006b).
• Childhood cancer is relatively uncommon but it is a leading cause of death among children aged 1-14 years. Cancer was the underlying cause of 18% of all deaths of children in this age group in 2004. The main forms of cancer causing death in children aged 1-14 years were brain cancer and leukaemia (ABS 2006b).
• In 2004, the main forms of cancer causing death amongst men were lung cancer (22%) (footnote 2), prostate cancer (13%), colorectal cancer and cancer of the lymphoid and related tissues (10%) (ABS 2006b).
• In females, the cancers most commonly causing death in 2004 were breast (16%), lung (15%), colorectal cancer (12%) and cancer of the lymphoid and related tissues (10%) (ABS 2006b).
• Although skin cancers are the most commonly diagnosed cancer in Australia, relatively few people die of this cancer if treated early (AIHW 2003).
• During 1992-97, the five-year relative survival proportions for all cancers for females (63%) were higher than those for males (57%). For cancer of the kidney, the five year survival rate was similar for males and females (60% and 58% respectively). Differences in survival rates between males and females were observed for people diagnosed with cancer of the bladder (71% and 65% respectively). The greatest difference in five year survival rates was experienced by people with Thyroid cancer with women having higher survival rates than men (96% and 88% respectively). There were similar five year survival rates for people with Hodgkin's Lymphoma (males 83% and females 84%) while for people with Leukaemia there was a slightly higher survival rate for women (43%) than for men (41%) (AIHW 2001).

Death rates for selected cancers (a) - 2004

• Cancer was the cause of 17% of all deaths reported for Indigenous Australians in 2004 (ABS 2006b).
• Cancers of the digestive organs and lungs (and other smoking-related cancers) are the most common types of cancer that lead to deaths among Indigenous Australians (ABS & AIHW 2003).
• In 2003-04, cancer was responsible for 1,070 and 1,344 hospitalisations of Indigenous males and females respectively, accounting for 1% of both Indigenous male and female hospitalisations. In each age group hospitalisations for cancer were lower for Indigenous Australians than for other Australians (ABS & AIHW 2005).
• In 2004-05, 29% of all Indigenous women aged 40 years and over had a mammogram and 49% of all Indigenous women aged 18 years and over had a pap smear at least once every two years (ABS 2006c). (See Mammograms, Pap smear and bowel cancer tests below for Non-Indigenous data.)

• In 2003, 62,400 people (2% of all people with a disability) reported that cancer was the main condition causing their disability. Of these people, 22,500 (36%) had a profound or severe limitation with communication, mobility and self care activities (ABS 2004).
• The most common cancers reported as the main underlying cause of disability were breast (15%), prostate (11%), colon (9%) and brain (7%) (ABS 2004).

• In 2004-05, cancer prevalence rates were similar for those living in areas with the greatest disadvantage (those in the lowest quintile of the index of socioeconomic disadvantage) and those living in areas with the least disadvantage (those in the highest quintile of the index of socioeconomic disadvantage) (footnote 3).
• In 2004-05, males living in the most disadvantaged areas of Australia were more likely to smoke than those in the least disadvantaged areas (25% compared with 12%). This higher use of tobacco by those in more disadvantaged areas translates into higher incidence and mortality from lung cancer (AIHW 2005a).
• In 2004, a study was undertaken to compare long term mortality trends between 1966 and 2001 among Australian men aged 20-59 years in two broad occupational groups that reflect socioeconomic status ('manual' and 'non-manual') (AIHW 2005a). The study found that males who lived in lower socioeconomic areas were more likely to work in manual occupations. In 2001, the mortality rate among males with lung cancer who worked in manual occupations was 90% higher than males with lung cancer who worked in non-manual occupations (AIHW 2005a).
• A 2005 study undertaken to examine health-related inequalities by socioeconomic disadvantage between 1989-90 and 2001 found that among females aged 25-64 years, those from disadvantaged areas were more likely to have never had a Pap smear, and of those who had previously had a Pap smear, those from disadvantaged areas were more likely not to have had one in the last two years, compared to those from the least disadvantaged areas (QUT & AIHW 2006).

• Mammographic screening for breast cancer is aimed specifically at all women aged 50-69 years without symptoms, although women aged 40-49 years and 70 years and older may also attend for screening (AIHW 2006b).
• The target group for cervical cancer screening is women aged 20-69 years and women aged over 70 years who have never had or who request a pap smear (AIHW 2005).
• From 2002 to 2004, a pilot screening program for bowel cancer aimed at people aged 55-74 years of age was conducted. As a result of the trial a national bowel cancer screening program will be phased in between May 2006 and June 2008. Some trials suggested that the mortality rate for bowel cancer could be reduced by 15-33% through such a program (AIHW 2006b).

• 1.6 million women participated in a breast screening program in 2002-2003. Of these women, 1.1 million (69%) were in the screening program target age group of 50-69 years (AIHW 2006).
• The proportion of women in the target population participating in the breast screening program rose from 52% in 1996-1997 to 57% in 2000-2001 before falling slightly to 56% in 2002-2003 (AIHW 2006b).
• In 2002-03, after adjusting for age differences (footnote 4), just under 3.4 million women (54%) aged 20 years and over had a Pap smear test. The highest participation rates were amongst women aged 45-49 and 55-59 years (66%) while the lowest participation rates were amongst women aged 75-79 and 80 years and over (7% and 2% respectively) (AIHW 2005).
• The participation rate of people who were invited to participate in the bowel cancer screening pilot program from 2002 to 2004 was 45% (AIHW 2006b).

• Leading a sedentary lifestyle, being overweight or obese, smoking, consuming high or risky levels of alcohol and maintaining a poor diet are all suspected risk factors in developing cancer (NHMRC 1999 & Cancer Council of Australia 2004).
• In 2004-05, 18% of people with malignant neoplasms were current daily smokers, 15% drank alcohol at risky or high levels, 76% did little or no exercise and 53% were either overweight or obese.
• In 2001, 12% (10,592 cases) of all new reported cases of cancer were attributed to smoking (AIHW & AACR 2004).
• The burden of disease caused by lung cancer is mostly attributable to tobacco smoking (AIHW 2006b).
• Checking the skin regularly helps detect changes and potential skin cancers (Cancer Council of Australia 2006 & AIHW 2004). In 2004-05, 62% of people reported that they regularly checked their skin for changes in freckles or moles.

• In the period 2002-03 to 2004-05, cancer related hospital separations have decreased by 2% (AIHW 2006a).
• Cancer-related hospital separations accounted for 7% of all hospital separations in 2004-05 compared to 9.7% in 2001-02 (AIHW 2006a).
• 7% of all same-day separations in 2004-05 were cancer-related (AIHW 2006a).
• In 2004-05, non-melanomic skin cancers (NMSC) (footnote 5) account for approximately 14% of all cancer-related hospital separations (AIHW 2006a).
• 58% of all cancer-related hospital separations in 2004-05 were for chemotherapy administration (AIHW 2006a).

• In 2000-01, health system expenditure on neoplasms (cancer) was $2.7 billion or 5% of all public health expenditure in Australia (AIHW & AACR 2004).
• 71% of this cancer-related expenditure was spent on in-patient, out-patient and day care services (AIHW & AACR 2004).